AIDET Physician

1 © 2008 Studer Groupwww.studergroup.com

Teaching Physician-Patient Communication (AIDET) for Results in All Pillars

Joe B (Bill) Putnam, Jr., MD, FACSProfessor and Chairman, Department of Thoracic Surgery

Vanderbilt University Medical Center, Nashville, TN

Julie Kennedy, RNStuder Group Coach

What’s Right in Health CareSM | Evidence to Outcomes

Presentation Objectives

• Identify the elements of AIDET and the results of this fundamental communication strategy in service, quality, safety, growth, cost and people pillar

• Understand the practical application of AIDET in physician-patient communication and connect it to current market issues

• Know how to make AIDET your own in your physician group through education, role modeling and creation of visual training module



Physicians and Communication

• 83% believe communication is as important as technical skill in patient outcomes

• 18% believe they have had good training in patient communication

-Physician Communication Skills Survey, 2001


GrowthPeople FinanceQualityService

Clinical Measures & Outcomes

Patient Satisfaction

Market Share Loyalty

Employee & Physician

Satisfaction

Revenue Targets Loyalty

AIDET – Results in All Pillars



Changes in Patient Perception of Care

0102030405060708090

100

Outpatient Inpatient ED

Baseline

6 Months Post

Source: 2007 AIDET product evaluation survey of PARTNERS and NONPARTNERS, N=68

Increase of 28%ile points

Increase of 17%ile points Increase of

16%ile points


AIDET - Quality

Physician communication, or the lack of it, is probably one of the most

important factors for patient non-compliance

Mayo Clinic Proceedings, 2005



AIDET - Quality

• 72% of patients unable to list medications they take

• 58% of patients unable to recite their own diagnosis

-Mayo Clinic Proceedings, 2005


“Because greetings are one way to ensure proper identification of patients, they may well be considered a fundamental component of

patient safety.”

AIDET - Safety

Source: Arch Intern Med. 2007;167(11):1172-1176.

An Evidence-Based Perspective on Greetings in Medical Encounters by Gregory Makoul, PhD; Amanda Zick, MA; Marianne Green, MD



AIDET – People - Physician Retention

~The most important

determinant of clinician global

satisfaction is the clinician-patient

relationship.

Physician turnover is a top concern and an important priority for leaders.Groups were asked to rank their concern of physician turnover. Forty-seven percent (47%) of all respondents indicate a strong concern about physician turnover.

(275 AMGA Medical Groups) -Suchmann et al, 1993


AIDET - Finance - Decrease Litigation

• Focus on Issues:Rounding, AIDET, Key Words, DCM

• Educate the Patient:Rounding, AIDET, Verify with DCM

• Enlist the Patient:Rounding, AIDET, Patient Visit Guide, IPC

• Share Decisions:AIDET, Key Words, IPC

The most common cause of malpractice suits is failed communication with the patients and their families. Explore ways that better communication could lead to fewer malpractice claims and allow health care organizations to reduce litigation costs.

IN THIS ARTICLE…

The Physician Executive, June 2004, Reducing Litigation Costs Through Better Patient Communication



AIDET – Finance - Decrease Litigation

0

10

20

30

40

50

60

70

1Q07 2Q07 3Q07

# of Complaints# of Compliments

*Data provided by University Medical Center, Tucson, AZ

**Source: 2007 AIDET product evaluation survey of PARTNERS and NONPARTNERS

50% decrease in complaints


AIDET - Finance and Growth

• For every customer that complains, 20 dissatisfied customers do not

• Of those dissatisfied customers who do not complain, 90% do not return

• The average wronged customer will tell 25 others

• It is 10 times more expensive to recruit new patients than to keep old ones

-Zimowski 2004



AIDET – Growth - HCAHPS

• Nurse communication (Q 1–3)• Doctor communication (Q 5–7)• Responsiveness of hospital staff (Q 4, Q 11)• Cleanliness, quiet of hospital environment (Q 8-9)• Pain management (Q 13-14)• Communication about medicines (Q 16-17)• Discharge information (Q 19-20)

~AIDET is the “ALWAYS”


AIDET - Patient Loyalty

“In fact the only path to profitable growth may lie in a company’s ability to get its

loyal customers to become its marketing department.”

-THE ONE NUMBER YOU NEED TO GROWFrederick F. Reichheld - Harvard Business Review Dec 2003



Five Fundamentals of Consistent Communication – Key Words

Safety

Loyalty

Decrease Anxiety

Quality

Patient Loyalty

Increase Compliance

A

I

D

E

T

Explanation

Thank You

Acknowledge

Introduce

Duration


Improved clinical

outcomes and increased

patient and physician

satisfaction

Advantages of AIDETSM

DecreaseAnxiety

IncreasedCompliance+ =

Improve Clinical Outcomes



ELEVATE


Why AIDET?

• A ‘protocol,’ e.g. structured• Practical • Straight forward• Do not have to reinvent the

conversation with every patient every time

• Take the skeleton and create your own model-> make a difference to the patient and their family!



Reflects Our Mission and Credo

• I make those I serve my highest priority

• I respect privacy and confidentially

• I communicate effectively

• I conduct myself professionally

• I have a sense of ownership

• I am committed to my colleagues


Acknowledge

• Eye Contact• Smile• Shake hands• Acknowledge everyone in the

room, bond with each person• Sit

AcknowledgeA



Introduce

• Name• Specialty• Wear a name badge!• Team• MANAGE UP…..

IntroduceI


Results: Teamwork Between Doctors, Nurses, and Staff: (IP)



Results: Teamwork Between Doctors, Medical Providers, Nurses, and Staff: (OP)


Duration

• OFFICE STAFF – How long to see the doctor?

• PHYSICIAN TIMELINESS -“Thank you for your patience, your time is valuable”

• How long will the test, procedure, appointment or admission actually take?

• How long will it take to get results?

DurationD



Explanation

• Active Listening• E&M activities• Clarifying questions• EmpathyExplain the treatment plan• Use language that patient and family

understand• Use key words• “Do you need more explanation”?

ExplanationE


Reality of Explanation

• During a 20 minute encounter– Physicians self-report spending 9 minutes

“providing information”– REALITY: Physicians spent 1.5 minutes

• The key driver for patient satisfaction– The quality and clarity of information that

patients receive from physicians



Results: Informing (You/Your Family Member) of Test or Exam Results? (Clinic)


Thank You

• Closing key words– Thank for choosing our clinic or hospital– Thank for waiting– Thank for coming in today– What other questions do you have?– Anything else we could have done to

make your visit any better?

Thank YouT



Hey! Lets Put on a Show!


So We Made a Movie!

• Create an institutional model for care• Distill elements for medical students,

nurses, residents, faculty, visiting physicians, etc.

• Promote consistency of message• Improve patient perception• Increase patient and physician satisfaction

– Overall quality of care– Likelihood to recommend




The Impact of the AIDET Movie

• Physician training• Inpatient and Outpatient orientation• Clinic training off campus• New employee orientation• Resident orientation



Like A Diversified Time Allocation Portfolio


Like Starting an Exercise Program


Thank You! Joe B (Bill) Putnam, Jr., MD, FACS

Professor and Chairman, Department of Thoracic SurgeryVanderbilt University Medical Center, Nashville, TN

Julie Kennedy, RNStuder Group Coach

AIDET Physician

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